The diabetes telemonitoring of patients in insulin therapy (DiaMont) trial: protocol for a randomized controlled trial

Background : The effect of telemedicine solutions in diabetes remains inconclusive. However, telemedicine studies have shown a positive trend in regards to glycemic control. The telemedicine interventions that facilitate adjustment of medication seems to improve glycemic control more effectively. Hence, it is recommended that future telemedicine studies for patients with diabetes include patient-specific suggestions for changes in medicine.

Hence, the aim of the trial is to explore the effect of telemonitoring in patients with type 2 diabetes (T2D) on insulin therapy. Methods : The trial is an open-label randomized controlled trial with a trial period of 3 months conducted in two sites in Denmark. Patients with T2D on insulin therapy will be randomized (1:1) to a telemonitoring group (intervention) or a usual care group (control).

The telemonitoring group will use a continuous glucose monitor (CGM), an insulin pen, an activity tracker, and smartphone applications throughout the trial. Hospital staff will monitor the telemonitoring group and contact the subjects by telephone repeatedly throughout the trial period. The usual care group will use a blinded CGM the first and last 20 days of the trial and will use a blinded insulin pen for the entire period.The primary endpoint will be changed from baseline in CGM time in range (3.9–10.0 mmol/L) 3 months after randomization.

Secondary endpoints include change from baseline in glycated hemoglobin (HbA1c), total daily dose, time above range, and time below range 3 months after randomization. Exploratory endpoints include health-related quality of life, diabetes-related quality of life, etc. Discussion:  The DiaMonT trial will test a telemonitoring setup including various devices.

Such a setup may be criticized, because it is impossible to determine which element(s) add to the potential effect. However, it is not possible and counterproductive to test the elements individually, since it is the full telemedicine setup that is being evaluated. The DiaMonT trial is the first Danish trial to explore the effect of telemonitoring on patients on insulin therapy.

Thus, the DiaMonT trial has the potential to form the basis for the implementation of telemedicine for patients with T2D in Denmark.